DEP/DUA/1/15/08 (Normalised version)

Grizel Frazer

(1777-1778)

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Grizel Frazer.

With disease of this patient a good deal of difficulty.

And must own equally at loss with regard both to name & to nature of affection.

At loss also to say whether whole symptoms belong to one disease or whether are to consider affection as of complicated nature

Principle part of complaint consists of local & transitory swelling in abdomen.

Not fixed to any particular part but has a progression through the abdomen

And sometimes begins at one place sometimes at another usually terminating in stomach.

Swelling propagated in this manner cannot depend on any fixed affection of viscus

Not infrequently merely arises from accidental flatus in bowels.

And this may be case with it in present patient.

While at same time unconnected with other parts of her disease.

While though less painful yet perhaps more threatening.

That is attacks of shivering & coldness succeeded by heat.

These well known to be most common characteristics of febrile accessions.

And to being such in present case some countenance given by impaired appetite & bound state of belly.

Yet to any supposition of this kind long continuation of disease a very strong objection.

Can hardly conceive febrile attacks from whatever cause produced to have subsisted for so long time without proving fatal.

Farther to be observed that these successions of cold, shivering & hot fits not with affection of circulation.

Do not as is commonly case with febrile paroxysms observe any regular period of [illegible]

From these particulars then inclined to [reject] supposition of being febrile.

And well known that feelings of heat & cold often the product of other causes.

With that sex Hysteria most frequent.

Particularly concomitant of Nervous affections.

And of none more frequent than of Hysteria.

A disease appearance of which perhaps under as great variety of forms as any other to which system subjected.

To this supposition gives some presumption that patient a female.

Perhaps still farther that here probable origin of disease from affection of uterus.

For while some parts of complaint dated from pregnancy others from delivery of twins.

From such a state although not always bad effects yet greater opportunity of morbid affection than from ordinary pregnancy.

And presumption that succeeding [illegible] discharge more excessive.

Hence then here causes which might be supposed to give chance of morbid affection of uterus.

And need hardly observe that once prevailing opinion that all hysteria affections from morbid state of this viscus.

This evidently appears exclusive of other circumstances from name of disease alone.

And hysteria a name as evidently supposes disease of womb as Pleuritic an affection of pleura or odontalgia of tooth.

Now indeed such conjecture respecting cause of disease exploded.

And admitted that if be not more particularly an affection of another part is at least disease of system.

Perhaps even may venture to assert that more immediately results from peculiar irritation of alimentary canal.

Yet although uterus not immediate cause of hysteria cannot be refused that affection of this viscus often a cause in more remote way.

More frequently results from diseased state of menstrual evacuation than from any other circumstance

Hence then cause of disease here an additional circumstance corroborating supposition.

Lastly supposition of Hysteria still farther corroborated by affection of senses.

True indeed, in this disease have not as in Epilepsy abolition of senses.

Yet in hysterical paroxysms these much more affected than in common febrile attacks.

In this part of affection then find much more near resemblance to hysteria than to fever.

And would naturally inquire how far other complaints also of patient referred also to same head.

Hysteria not indeed marked by obvious swelling in abdomen.

Nor in common attended with any [remarkable] pain there

Yet one of most frequent symptoms sense of ball moving in abdomen.

And not only rising as in present case to stomach but even through tract of oesophagus to fauces.

When reaches that place gives sense of suffocation so frequently a distressing symptom in this affection.

This sense of ball moving in belly well known by title of globus hysteria by some considered as pathognomonic of the affection.

This opinion indeed am not disposed to adopt

Yet no one will refuse that at least a very frequent occurrence in the affection.

And although complaint as here described by patient not exact resemblance to it, yet in several particulars approaches it.

On whole then disposed to consider this as part also of same affection.

Would then view her as subjected not to complication of diseases but to one only.

And to that would give name of hysteria

Must indeed allow that if compare it with nosological¹ definition in most accurate [illegible] does not bear to these exact correspondence.

Perhaps however this rather to be ascribed to variety of appearances which disease puts on than to any other cause

And indeed to be observed that from this circumstance definition of Hysteria very different matter.

Hence it is that best nosologists have defined it in very different ways.

For if consult these definitions will hardly think that define same disease

Can therefore have less hesitation in giving same name to different variety.

At same time not without diffidence that pronounce this patients disease to be Hysteria.

And would even qualify what have said by viewing it as instance somewhat anomalous.

Have thus delivered opinion as to what disease is next to say how I imagine it will terminate.

And here must own hopes by no [means] sanguine.

Hysteria in general an affection in nature obstinate.

And particularly so when as in present case occurs not in most regular form but with anomalous symptoms.

Is farther unfavourable that has already subsisted for so long time.

And that patient already at advanced period of life.

Hence no chance of recovery from those revolutions to which female system [subjected]

While however thus dread obstinacy of disease must own not disposed to consider it as dangerous.

If indeed cold & hot fits of nature different from what here conjected may be sooner fatal than aware of.

But if conjectures well founded more alarming than dangerous.

And this indeed, is in general case with affections of hysteria kind.

Is then an affection where neither look for speedy termination in death nor recovery.

And not even any great prospect of affording much relief

This the rather to be dreaded as from measures hitherto adopted, have as yet made but very little progress.

Am then very doubtful how far shall even be able to alleviate patients affection

But if this accomplished is I must own utmost of expectations with present patient.

As to practice in this case may be observed that in such affections in general two great objectives in treatment

The mitigation or shortening of fits when present & the prevention of return.

First intention chiefly to be answered by such medicines as exert immediate affect on Nervous [power]

And by this means counteracting tendency to spasmodic or convulsive affections in muscular fibres.

Prevention of return to be aimed at in different ways. But principally.

By anticipating fits

By removing such causes as will serve to excite them

Or by removing condition of system without which exciting causes will not have affect.

In practice with present patient have used measures with view of accomplishing all these ends.

Cannot however say that with any of them have had the success that could have wished.

Yet shall briefly mention what aimed at by each.

And on what future plans am to attempt cure or alleviation of remaining complaints.

First began by directing for patient the use of Pill Gummos.

These chiefly intended to obviate swelling of abdomen mentioned in case.

Which hoped might do either on supposition of being strictly Globus Hysteria or arising from flatulence.

As in both cases hoped would result from influence of Assafoetida as an Antispasmodic.

While at same time expected might keep belly open.

Did not however fulfil wishes in either respect

Substituted therefore as more active [purge] the vinum aloetic.

And this combined with the Assafoetida under form of Tincture Fuliginis.

For in this Tincture principally active ingredient is the Assafoetida.

And is chiefly in menstruum that differs from Tincture Foetid.

From this at first seemed to derive some temporary relief.

But in way of moving belly went farther than could have wished.

And this even case after dose very considerably diminished.

From any evacuation however, great reason to believe that disease would be augmented.

And with view of preventing return of fits put patient on course of Zinc with Valerian.

With view of anticipating them after threatening should occur directed Aether.

What will be affect of this course cannot yet pretend to say.

But if affords any relief shall wish to persist without alteration.

If not may try her with course of Peruvian Bark.

And in case both prove abortive shall be very glad to dismiss patient, if at any time even temporary mitigation of symptoms.

And if state of strength will admit of it notwithstanding apparent febrile attacks may in spring recommend cold bathing

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.